Ohkawa Toshika, Nakao Naoyuki, Uematsu Yuji, Itakura Toru
Department of Neurological Surgery, Wakayama Medical University, Wakayama, Japan.
Skull Base. 2010 Nov;20(6):481-6. doi: 10.1055/s-0030-1261261.
A basal encephalocele often shows an insidious clinical course. Only two cases of temporal lobe encephalocele accompanied with tension pneumocephalus have previously been reported. In this paper, we describe a case of lateral sphenoid sinus encephalocele presenting with intraventricular tension pneumocephalus. A 54-year-old man was referred to our institution presenting with intraventricular tension pneumocephalus. He had undergone ventriculoperitoneal shunt placement for postmeningitis hydrocephalus 3 months before this admission. Precise imaging examinations detected evidence suggestive of a lateral sphenoidal sinus recess encephalocele. Endoscopic transnasal approach was performed for surgical repair of the encephalocele. The encephalocele was removed with subsequent repair of the bony defect. Histological examination showed that the encephalocele includes a part of the ventricular system. This indicates that air might enter directly into the ventricular system after rupture of the temporal lobe encephalocele. A lateral sphenoid sinus encephalocele would potentially cause intraventricular tension pneumocephalus, although pneumocephalus is an extremely unusual complication of this type of basal encephaloceles.
基底脑膨出通常表现为隐匿的临床病程。此前仅有两例颞叶脑膨出合并张力性气颅的病例报道。在本文中，我们描述了一例伴有脑室内张力性气颅的外侧蝶窦脑膨出病例。一名54岁男性因脑室内张力性气颅被转诊至我院。此次入院前3个月，他因脑膜炎后脑积水接受了脑室腹腔分流术。精确的影像学检查发现了提示外侧蝶窦隐窝脑膨出的证据。采用鼻内镜经鼻入路对脑膨出进行手术修复。切除脑膨出并随后修复骨缺损。组织学检查显示脑膨出包含脑室系统的一部分。这表明颞叶脑膨出破裂后空气可能直接进入脑室系统。外侧蝶窦脑膨出可能会导致脑室内张力性气颅，尽管气颅是这类基底脑膨出极为罕见的并发症。
